vmireavizВестник медицинского института «РЕАВИЗ». Реабилитация, Врач и ЗдоровьеBulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH)2226-762X2782-1579РЕАВИЗ10.20340/vmi-rvz.2025.5.CLIN.6vmireaviz-1324Research ArticleКлиническая медицинаClinical medicineСовременные реалии хирургического лечения мягкотканных дефектов методами тканевого растяженияCurrent approaches to surgical treatment of soft tissue defects using tissue expansion techniqueshttps://orcid.org/0000-0002-9901-8520КабановМ. Ю.KabanovM. Yu.

Кабанов Максим Юрьевич, д-р мед. наук, начальник, Народная ул., 21, корп. 2, г. Санкт-Петербург, 193079;

профессор кафедры общей хирургии, Пискаревский пр., д. 47, г. Санкт-Петербург, 195067

Maksim Yu. Kabanov, Dr. Sci. (Med.), Head of the Hospital, Narodnaya st., 21, bldg. 2, St. Petersburg, 193079;

Professor, Department of General Surgery, Piskarevsky pr., 47, St. Petersburg, 195067

makskabanov@gmail.ruhttps://orcid.org/0000-0001-8146-4728ГлушковН. И.GlushkovN. I.

Глушков Николай Иванович, д-р мед. наук, профессор, заведующий кафедрой общей хирургии, Пискаревский пр., д. 47, г. Санкт-Петербург, 195067;

Народная ул., 21, корп. 2, г. Санкт-Петербург, 193079

Nikolay I. Glushkov, Dr. Sci. (Med.), Professor, Head of the Department of General Surgery, 

Piskarevsky pr., 47, St. Petersburg, 195067;

Narodnaya st., 21, bldg. 2, St. Petersburg, 193079

nikolay.glushkov@szgmu.ruМирошниченкоВ. О.MiroshnichenkoV. O.

Мирошниченко Вячеслав Олегович, врач-хирург отделения гнойной хирургии, 

Народная ул., 21, корп. 2, г. Санкт-Петербург, 193079

Vyacheslav O. Miroshnichenko, Surgeon, Purulent Surgery Department,

Narodnaya st., 21, bldg. 2, St. Petersburg, 193079

Miroshnichenko_j@mail.ruhttps://orcid.org/0009-0000-0079-4849ГоршенинТ. Л.GorsheninT. L.

Горшенин Тимофей Леонидович, д-р мед. наук, заместитель начальника госпиталя по хирургии, Народная ул., 21, корп. 2, г. Санкт-Петербург, 193079;

доцент кафедры общей хирургии, Пискаревский пр., д. 47, г. Санкт-Петербург, 195067

Timofey L. Gorshenin, Dr. Sci. (Med.), Deputy Head of the Hospital for Surgery, Narodnaya st., 21, bldg. 2, St. Petersburg, 193079;

Associate Professor, Department of General Surgery, Piskarevsky pr., 47, St. Petersburg, 195067

tgorshenin@mail.ruhttps://orcid.org/0000-0002-8226-3757БиниенкоМ. А.BinienkoM. A.

Биниенко Михаил Анатольевич, канд. мед. наук, заведующий отделением гнойной хирургии № 6,

Народная ул., 21, корп. 2, г. Санкт-Петербург, 193079

Mikhail A. Binienko, Cand. Sci. (Med.), Head of Purulent Surgery Department No. 6, 

Narodnaya st., 21, bldg. 2, St. Petersburg, 193079

Binienkom@mail.ruhttps://orcid.org/0000-0001-7998-9277ИзмайловС. Г.IzmaylovS. G.

Измайлов Сергей Геннадьевич, д-р мед. наук, профессор, профессор-консультант, 

ул. Октябрьской революции, д. 66а, г. Нижний Новгород, 603011

Sergey G. Izmaylov, Dr. Sci. (Med.), Professor, Consulting Professor,

st. October Revolution, 66a, Nizhny Novgorod, 603011

izi28082009@yandex.ruhttps://orcid.org/0009-0005-8676-9930БогдановС. Н.BogdanovS. N.

Богданов Сергей Николаевич, канд. мед. наук, врач-хирург, 

ул. Октябрьской революции, д. 66а, г. Нижний Новгород, 603011

Sergey N. Bogdanov, Cand. Sci. (Med.), Surgeon, 

st. October Revolution, 66a, Nizhny Novgorod, 603011

SBogdanov2007@yandex.ruГоспиталь для ветеранов войн; Северо-Западный государственный медицинский университет им. И.И. МечниковаРоссияHospital for war veterans; North-Western State Medical University named after. I.I. MechnikovaRussian FederationГоспиталь для ветеранов войнРоссияHospital for war veteransRussian FederationГородская клиническая больница № 7 им. Е.Л. БерезоваРоссияCity Clinical Hospital No. 7 named after. E.L. BerezovaRussian Federation2025270120261556977Copyright © Кабанов М.Ю., Глушков Н.И., Мирошниченко В.О., Горшенин Т.Л., Биниенко М.А., Измайлов С.Г., Богданов С.Н., 20262026Кабанов М.Ю., Глушков Н.И., Мирошниченко В.О., Горшенин Т.Л., Биниенко М.А., Измайлов С.Г., Богданов С.Н.Kabanov M.Y., Glushkov N.I., Miroshnichenko V.O., Gorshenin T.L., Binienko M.A., Izmaylov S.G., Bogdanov S.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestnik.reaviz.ru/jour/article/view/1324Актуальность

Актуальность. Проблема закрытия обширных раневых дефектов представляет сложную задачу современной хирургии. Рост числа техногенных катастроф, дорожно-транспортных происшествий, боевых действий и террористических актов обусловливает увеличение количества пострадавших с обширными дефектами мягких тканей, которые невозможно устранить традиционным способом наложения швов.

Цель исследования — анализ современного состояния проблемы закрытия раневых дефектов методами острого и дозированного тканевого растяжения на основе данных отечественной и зарубежной литературы.

Материалы и методы

Материалы и методы. Проведён анализ научных публикаций, посвящённых методам тканевой дистракции, представленных в базах данных PubMed, eLibrary, CyberLeninka. Рассмотрены конструктивные особенности и клиническая эффективность современных устройств для экзогенного тканевого растяжения.

Результаты

Результаты. Представлена классификация раневых адаптационно-репозиционных аппаратов (РАРА) с разделением на пять подгрупп: игольчатые, нитевые, спицевые, стержневые и клеевые. Описаны принципы работы внутритканевых аппаратов (экспандеров) и внетканевых устройств. Проанализированы преимущества и ограничения каждого метода, показания и противопоказания к их применению. Освещены современные тенденции совершенствования аппаратов, включая автоматизированный контроль тензии и математическое обоснование параметров дистракции.

Заключение

Заключение. Метод дозированной тканевой дистракции является перспективным направлением лечения пациентов с обширными раневыми дефектами, способствующим сокращению сроков госпитализации и снижению затрат на лечение. Необходима дальнейшая разработка новых устройств и алгоритмов, адаптированных к индивидуальным особенностям раневых дефектов.

Background

Background. The problem of closing extensive wound defects remains a challenging task in modern surgery. The increasing number of technogenic disasters, road traffic accidents, military operations, and terrorist attacks leads to a rise in patients with extensive soft tissue defects that cannot be managed using conventional suturing techniques.

Objective

Objective. To analyze the current state of the problem of wound defect closure using acute and gradual tissue stretching methods based on domestic and international literature data.

Materials and methods

Materials and methods. An analysis of scientific publications on tissue distraction methods from PubMed, eLibrary, and CyberLeninka databases was conducted. The design features and clinical effectiveness of modern devices for exogenous tissue stretching were reviewed.

Results

Results. A classification of wound adaptation-repositioning devices (WARD) is presented, divided into five subgroups: needle-type, suture-type, wire-type, rod-type, and adhesive-type. The principles of operation of intratissue devices (expanders) and extratissue devices are described. The advantages and limitations of each method, as well as indications and contraindications for their use, are analyzed. Current trends in device improvement, including automated tension control and mathematical justification of distraction parameters, are highlighted.

Conclusion

Conclusion. The method of gradual tissue distraction is a promising approach for treating patients with extensive wound defects, contributing to reduced hospitalization duration and treatment costs. Further development of new devices and algorithms adapted to individual wound defect characteristics is required.

раневые дефекты [D014947]тканевое растяжение [D015626]реконструктивные хирургические процедуры [D019651]хирургические лоскуты [D013524]травмы мягких тканей [D017695]заживление ран [D014945]взрывные повреждения [D000070642]пластическая хирургия [D013518]кожная пластика [D016038]методы закрытия ран [D058106]wounds and injuries [D014947]tissue expansion [D015626]reconstructive surgical procedures [D019651]surgical flaps [D013524]soft tissue injuries [D017695]wound healing [D014945]blast injuries [D000070642]surgeryplastic [D013518]skin transplantation [D016038]wound closure techniques [D058106]ReferencesПархомчук Д.С. Организация проведения лечебно-эвакуационных мероприятий в условиях локального вооруженного конфликта. Медицина катастроф. 2018;4(104):14-17.Parkhomchuk D.S. Organization of medical evacuation measures in the context of a local armed conflict. Disaster Medicine. 2018;4(104):14-17. (In Russ.)Дубинкин ВА, Халиман АС. 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The authors declare that there are no conflicts of interest present.